Ted is a 38 yo male (established patient) who presents to your office

  

Ted is a 38 yo male (established patient) who presents to your office due to 9-month history of fatigue, weight loss of approximately 10lbs in the last 3-6 months, and night sweats. His only significant previous medical history was the repair of a ventricular septal defect and patent ductus arteriosus as an infant. He took no prescribed or over-the-counter medications, had never smoked cigarettes, ETOH use: 2-3 drinks per week and pt mentions that he had a twin brother that died 3 years ago.

Abnormal findings on examination were hepatosplenomegaly and supraclavicular, axillary, and inguinal lymphadenopathy.

Question 1

What other questions would you ask the patient?

Question 2

What systems should be included in his exam and why? (I have already given you a few hints)

Question 3

After asking more questions Ted admits that he has abdominal pain, vomiting with large meals occasionally, and noticed he has trouble with swallowing during meals unless he has “lots of water”. Based on the information you have be given, what are at least 3 differential diagnoses you may consider?

Question 4

What further investigation/work-up would a provider consider (labs, scans, referrals)?

Question 5

What type of follow-up would you schedule for this patient and why?

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